Comparison The Effects Of Different Anesthesia Regimens On The Adverse Reactions In Painless Gastroscopic Patients

Objective:To compare the effects of propofol alone or combined respectively with dexmedetomidine,sufentanil,nalbuphine on adverse reactions of patients in painless gastroscopy,in order to improve the perioperative safety of patients with painless gastroscopic examination,and thus to reduce the complications of painless gastroscopy.Methods:A total of 200 male patients were selected from September,2017 to March,2018 who underwent painless gastroscopy in The Second Affiliated Hospital of Kunming Medical University.All the patients had no history of dizziness/vertigo and nausea and vomiting,with a physical status according to American Society of Anesthesiologists(ASA)Ⅰ～Ⅱ,ranging from 18 to 65 years old and BMI30kg/m2.The patients were randomly divided into four groups(n=50):Propofol group(group P),dexmedetomidine combined propofol group(group DP),sufentanil combined propofol group(group SP)and nalbuphine combined propofol group(group NP).Then we administrate the experiment as follow.(1)Group P:propofol 1.5 mg/kg intravenous injection(2 min before examination).(2)Group DP:Intravenous drip of dexmedetomidine 0.3 ug/kg(10 min before examination)and propofol 1.5 mg/kg intravenous injection(2 min before examination).(3)Group SP:Intravenous injection of sufentanil 0.1 ug/kg(4 min before examination)and propofol 1.5 mg/kg intravenous injection(2 min before examination).(4)Group NP:Intravenous injection of nalbuphine 0.2 mg/kg(4 min before examination)and propofol 1.5 mg/kg intravenous injection(2 min before examination).Waiting until the Ramsay scored up to 4 points,we start the endoscopic operation.If not,we will add a bolus of propofol 0.5 mg/kg and/or repeat the dosage until the Ramsay scored reaching 4 points.If the gastroscopic examination is affected by body movement and swallowing reflex of patients,propofol 0.5 mg/kg will be added to maintain appropriate depth of anesthesia.We record the change of patients ’heart rate(HR)、mean arterial pressure(MAP)、pulse oxygen saturation(SpO2)and Ramsay score at 6 time points:baseline(T0)、the gastroscope passed through the glottis(T1)、3 min after gastroscope inserted(T2)、when the patient opening eyes after the examination(T3)、5 min after the patient transferred to the recovery room(T4)、the patient leaving the recovery room(T5).In addition,we recorded the patients’visual analogue score(VAS)when leaving the recovery room.Besides,the total dosage of propofol at the end of examination and awakening time of patients in each group were observed.Furthermore,we statistically analyzed the incidence of intraoperative adverse reactions which include cough,body movement,hypoxemia,respiratory depression,hypotension and bradycardia.Moreover,we counted the incidence of adverse reactions occurred after entering the recovery room which includes nausea,vomiting and dizziness/vertigo.Results:1.The general data of patients in each group:age,height,weight,ASA classification and examination time,there was no statistical significance(P>0.05).2.Vital signs measurements:At Ti,HR and MAP of group P were higher than those in group DP,group SP and group NP,the difference was statistically significant(P<0.05).At T2,MAP and SpO2 of group P were lower than those in group DP,group SP and group NP,the difference was statistically significant(P<0.05).From T1 toT3,HR of group DP was lower than that in group P,group SP and group NP,the difference was statistically significant(P<0.05).In addition,there was no significant difference of HR,MAP and SpO2 between the other groups at different time points(P>0.05).3.The effects of sedation:From T1 toT3,the Ramsay sedation score of group DP was higher than that in group P,group SP and group NP.Moreover,the Ramsay sedation score of group P at T1 was the lowest,and the difference was statistically significant(P<0.05).In addition,the Ramsay sedation score between the other groups were not statistically significant.(P>0.05).4.The VAS score of the four groups were less than 4 when the patients left the recovery room,and there was no significant difference between the four groups(P>0.05).5.The total dosage of propofol and awakening time of the patients in group P were higher than those in group DP,group SP and group NP,the difference was statistically significant(P<0.05).6.Incidence of intraoperative adverse reactions:The incidence of cough,body movement,hypoxemia,respiratory depression and hypotension in group P were higher than those in group DP,group SP and group NP(P<0.05).Besides,the incidence of bradycardia in group DP was higher than that in group P,group SP and group NP(P<0.05).7.Incidence of postoperative adverse reactions:The incidence of nausea and vomiting in group NP was the lowest compared with in group P,group DP and group SP,the difference was statistically significant(P<0.05).Moreover,there was no significant difference in the incidence of dizziness/vertigo among the four groups(P>0.05).Conclusions:1.Nalbuphine combined with propofol for sedation during painless gastroscopy accounts for the lowest incidence of intraoperative adverse reactions which include cough,body movement,hypoxemia,respiratory depression,hypotension and bradycardia than propofol alone or combined respectively with dexmedetomidine,sufentanil.2.During painless gastroscopy,the patients who use nalbuphine combined with propofol for sedation shows lower incidence of postoperative adverse reaction which includes nausea and vomiting,greater anesthesic effect and higher rate of safety compared with propofol alone or combined respectively with dexmedetomidine,sufentanil.